摘要:

Purpose of reviewThis article describes the clinical papers published in 2002 and early 2003 on nutritional and metabolic derangement in inflammatory bowel disease.Recent findingsInsulin-like growth factor 1 and Insulin-like growth factor binding protein 3 are decreased in inflammatory bowel disease, and disease therapy hardly reverses this situation. There are promising data on recombinant human growth hormone therapy in paediatric inflammatory bowel disease. Several papers have added some fuel to the debate on the prevalence and pathogenesis of metabolic bone disease in inflammatory bowel disease. Articles have been published investigating the role of dietary fat in the therapeutic action of enteral feeding in Crohn's disease. Low-fat diets are particularly useful, and adding medium-chain triglycerides does not impair the effectiveness of these diets. Balanced amounts of saturated, monounsaturated and polyunsaturated fat should probably be used. Relevant contributions on the usefulness of probiotic preparations (VSL#3) in the treatment and prevention of pouchitis have been published. Other papers deal with the effects of medical and surgical therapy on body composition and metabolism in the inflammatory bowel disease, the treatment of oxidative stress of these patients, and the possible role of some vitamin deficiencies on thrombotic risk in the condition.SummaryInflammatory bowel disease therapy hardly reverses growth hormone-insulin-like growth factor 1 disturbances of patients. The role of inflammation and steroid therapy of metabolic bone disease in inflammatory bowel disease is still controversial. Low-fat diets, with added amounts of medium-chain triglycerides, are useful in decreasing gut inflammation in the condition. The search for the optimal dietary fatty acid composition deserves further investigations. The use of probiotics and prebiotics opens new therapeutic perspectives for the disease.

ISSN:1363-1950    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe provision of nutrition to patients with advanced digestive cancer, especially those with obstruction, has been an issue discussed by physicians, administrators and patients themselves. There is no real consensus about this topic, perhaps because of the fact that this discussion involves medical, emotional, ethical, economical and legal considerations that are not easily encompassed by any single decision. On the other hand, the quality of life or survival of these patients must be thoroughly evaluated because one of the basic tenets of medicine has always been ‘primum non nocere’ (‘above all, do not harm’). Quality of life itself is a complicated concept because it has no specific definition and varies with each individual and depends upon his/her actual living reality, past experiences, future hopes, dreams and even ambitions.Recent findingsRecent studies have presented controversial results when evaluating the benefits of providing nutritional therapy to patients with advanced digestive cancer with obstruction. Therefore, decision-making should be addressed on an individual basis, but at the same time should be based on defined protocols within each institution. A key factor to be considered is communication among all those involved in the process; most important is the role of the patient and his/her family, who should be able to communicate their feelings, concerns and ethical principles.SummaryNutritional therapy in advanced digestive cancer is an instrument that should be evaluated as an extra tool that may offer improved quality of life to those with obstruction, despite the associated increased costs. However, in this delicate matter, our decisions should not be driven by increased pressure by medical system administrators to limit financial expenditure.

ISSN:1363-1950    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis paper will summarize the most recent clinical and experimental data on the effects of prebiotics in inflammatory and cancerous diseases of the large intestine.Recent findingsAnimal studies, as well as data obtained in in-vitro cell culture systems, have underlined the potential of certain prebiotics to protect against inflammatory and cancerous processes in the large intestine. Clinical trials are now in progress to assess the relevance of these promising results. The biochemical mechanisms are still incompletely deciphered, but both the promotion of lactic acid-producing bacteria and the production of short-chain fatty acids, particularly butyrate, during the fermentation of prebiotics could be key factors.SummaryEnteric resident bacteria are involved in inflammatory bowel diseases and may contribute to colonic carcinogenesis. Dietary manipulation of the flora may thus represent a useful aid to prevent or to treat these diseases, and this could be a place for prebiotics. Inulin-like prebiotics have shown encouraging results in animal models, but clinical and epidemiological trials are necessary to define their efficacy in humans. In the next few years, important advances are expected in understanding the interactions between prebiotics, intestinal flora and the colonic mucosa in health and diseases, enabling the improvement of therapy as well as better nutritional handling of susceptible individuals.

ISSN:1363-1950    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewRecognition that the gastrointestinal tract is a key element of the immune system has led to a greater interest in understanding its role as a central figure in host defenses. Biologic systems that are perturbed by any destabilizing stimulus are known to respond by adaptive strategies in an attempt to maintain or return to global homeostasis. In critically ill patients, the gut has previously been described as a promoter of progression to sepsis and multi-organ failure. However, with better understanding of gastrointestinal tract mucosal immunity, we are now provided with a new arsenal to combat nosocomial infection and significantly impact return to health.Recent findingsIn this review we focus on five key topics in the rapidly expanding landscape of knowledge on the gastrointestinal tract in the critical care setting. These include a discussion of probiotic therapy, now the new frontier of immuno-nutrition, the concept of ischemia/reperfusion injury and changes in gut permeability, anti-oxidant and micronutrient therapy, blood glucose regulation, and enhancement of gut motility, all in the intensive care setting.SummaryOngoing research in nutritional support in both normal and pathologic gastrointestinal function and response to injury has opened the door to several new opportunities for enhancing rapid recovery in critical care.

ISSN:1363-1950    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewConventional perioperative care includes a period of semistarvation before bowel function returns and adequate oral intake is allowed. It has been clearly shown that there is no need for restriction in oral intake after, at least lower, gastrointestinal surgery, and that early oral feeding does not increase the risk for dehiscense of the anastomosis. In contrast, early feeding reduces postoperative complications. Even if early oral intake is allowed, however, it is common that side effects such as nausea and vomiting prevent patients from reaching the target energy intakes. Thus, developing routines and treatments that promote sufficient early oral intake after surgery and maintain adequate energy intake in the postoperative period are probably of great importance for the outcome from surgery.Recent findingsThere are a number of factors which may facilitate early oral intake after gastrointestinal surgery including effective pain relief using epidural anaesthesia while avoiding opioids, minimizing sodium and fluid administration perioperatively and substantially reducing preoperative fasting. In addition, sufficient preoperative information, intensive mobilization, energy-dense hospital food and oral supplements may all contribute to improved energy intake after surgery.SummaryIn general, there is a great need for randomized controlled trials examining factors important for the regulation of oral intake after surgery and also the effects of early oral intake after upper gastrointestinal surgery. Future areas of research may also include regulation of appetite and use of peripherally acting opioid antagonists.

ISSN:1363-1950    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1363-1950    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1363-1950    

出版商:OVID    

年代:2003

数据来源: OVID